O3227: Identifying variables associated with success, quality, and resilience in outpatient pediatric palliative care program design and workflow

Background: Inpatient pediatric palliative care (PPC) programs are growing into the outpatient setting, heeding the call of national organizations including the American Academy of Pediatrics, the National Coalition for Hospice and Palliative Care, and the Center to Advance Palliative Care (CAPC) to offer PPC across care settings. Yet evidence demonstrates that expanding PPC programs continue to face high patient volumes with limited staffing resources. To improve the sustainability of these programs, we aimed to describe different approaches for operationalizing outpatient pediatric palliative care (OPPC) and how these processes may influence clinician perceptions of OPPC programmatic success, quality of care, and team resilience.

Methods: As part of a national cross-sectional study analyzing OPPC clinic development, structure, and workflow, 48 freestanding children’s hospitals with established inpatient PPC programs identified by CAPC were queried regarding the existence and operationalization of OPPC and their perceptions of programmatic success, quality of care, and team resilience. The survey was completed in Spring 2021, and participants were asked to base their responses on pre-March 2020 experiences (prior to the COVID-19 pandemic in the United States). Kruskal-Wallis rank sum tests were performed to identify variables associated with self-reported success, quality, and resilience.

Results: Twenty-eight of the 36 (78%) responding programs reported OPPC provision in a clinic setting; of these, 89% (25/28) self-reported their program’s success, quality of care, and team resilience. Among these 25 programs, most reported that their OPPC program design and workflow facilitated high quality care (19/25, 76%). About half felt that their design and workflow was successful (13/25, 52%) and promoted team resilience (12/25, 48%). OPPC programs with a dedicated clinic space reported increased success of their program (p=0.003). Furthermore, programs utilizing a free-standing clinic model were significantly associated with increased perceptions of OPPC programmatic success and provision of high-quality care compared to floating (PPC providers “float” between scheduled non-PPC clinic visits across various subspecialties) and embedded (PPC providers are fully integrated members of the primary care or subspecialty team) clinic models (Figure 1). No significant associations were identified between program success, quality, and team resilience and program age, hospital size, total program or billable staffing full time equivalent, or 24/7 availability. Programs who felt their design and workflow promoted team resilience were more likely to report that their design and workflow also facilitated provision of high-quality care (Figure 2).

Conclusion: Specific facets of OPPC program design and workflow may influence clinician perceptions of program success, provision of high-quality care, and team resilience. More research is needed to investigate the potential benefits of free-standing clinic models on improving OPPC programmatic success and overall quality of care provision. Future work will center on shareholder-driven development of quality metrics specific to OPPC clinic models to help inform and guide future expansion.